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APPLICATI�..� FOR CONSTRUC7.JN PERMIT <br />CITY OF EVERETT • BUILDING DIVISION <br />3200 CEDAR STREET • EVERETT, WA 98201 • 259-8810 <br />❑ DEMOLITION ❑ COMBINATION f'( BUILDING ❑ MECHANICAL fl PLUMBIN(i ❑ SIGN <br />PROJECT ADDRESS ' <br />2/Z6 .�A�/an-r.�� <br />vnncn e•wi�wuUHE55 e CITY ZIP PHpNE <br />�AwREr[,� n�n d�n�r� N�t �ba�j� •ti;1 h�6H�i �srt9Yc�� t� �-i YS� <br />TEN�NT M�11L�DORE55 LITY 21P PIIONE <br />ARCHITECTOqpE51GNER M�IL�DDRE55 GTV ZIP PHONE <br />GENERALCONTfl�GTOR MAILAD�RESS C:TY 21P PHONE STATELICENSEII <br />�A�Ikti, Gov.ff zi3iHi�N,,�,.a fv�a;T `IB+A� 2.S1-�X.ld N�4Cfx41 t2oa/� <br />MECXANICAICONTRACTOR MAILADpqESS CITY ZIP PHONE STATELICENSE� <br />PLUMBINGCONTRIICTOR M�IUWRE55 Cltt ZIP PNONE STATEUCENSE� <br />DpESCR�IBrE W3RN �ND SOUARE FOOT�GE INVOI <br />F fi/ •1r��,.iND lidh !a-f 1 <br />�Or�%U� /'6/�'�iI k'y/' <br />PROPOSED USE OF BUILDIN� <br />RP�tir�,� Ho�sE <br />lEOAL DESCRIPiION OF PROPEFTV �SMOVR! & <br />LO7 �Lf? T N�tu ;O BLOCK ��_ <br />ATfACH TWp COPIES) <br />���y�� ".,, ����T ���YS 3 Y— 4S3 — 6 L�.� — u c o y <br />CONS1AlICTION LO�N LENDER, �DDRESS. TELEPHONE NUMBER <br />PLUMBINO <br />NO. TYPE OF flXT <br />WATER CLOSET (TOIL <br />BATHTUB <br />LAVATORY(WASH BA'. <br />SHOWER <br />KITCHEN SINK 8 DISP <br />DISHWASHER <br />LAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKINO FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PHEVENT <br />SINK (SERVICE — BAP <br />FOR OFFICE USE ONLY: <br />FRONTSETBACK AEAR: <br />USEZONE <br />HEIGHT LIMITATION <br />OCCUPANCY NpC <br />GROUP <br />FIPE AUPM REO'D <br />FIRE SPRINKLER Rf <br />iYPE OF CONST <br />SUB TOTAL $ <br />IOTAREA <br />NO. OF OWELLING <br />UNITS <br />OCCUPANTIOAD <br />REASON <br />REASON <br />PUNS APPROVE7 BV <br />HEATING SYSTEM: ❑ GAS GJ'ELECTRIC ❑ <br />CONTACT PERSON AND PHONE NO. <br />I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF LAWS AND ORDINANCES OOVERNINO THIS TVPE OF <br />WORK WIIL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR <br />NOT. THE GRANTING OF A PEFMIT DOES NOT PRESUME TO OIVE <br />AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY <br />OTHER STATE OR LOCAL LAW REOULATINO CONSTRUCTION OR THE <br />PE'1FORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br />OWNEfi OF THIS PROPERTY TO PERFORM THE WORK WR WHICH <br />APPLICATION IS MADE AND 1 COMPLY WITH THE STATE <br />CONTRACTORS LAW 7827 RCW AND 298200 WAC. <br />�I ��-�C iz - /l- 9r <br />X 6• <br />SI �iURE U�TE <br />CITY BUSINE55 LICENSE NO. <br />FEE NO. TYPE OF FlXTURE OR ITEM <br />� A/C —AMNDLG UNITS — H.P. <br />; FORCED AIR SYSTEMS — B.T.U. M E.A. <br />� HEAT PUMP <br />FEE $ � <br />SIOE SETBACK <br />VACANT SITE <br />f1YE5 fl NO <br />SIZE OF BLDGR.I. <br />BASEMENT <br />❑vES C7 NO <br />UNIT HEATERS — B.T.U. <br />CLOTNES DRYERS <br />VEPlTILATION FAN <br />WATER HEATER <br />WOOD STOVE <br />FIREPLACEINSERT <br />GAS FIREPLACE <br />GAS RAN(iE <br />EXHAUST FAN <br />PIAN CHECK NUMBER <br />BIIIIDING <br />PIUMBING <br />MECMANICAL <br />ADDITIONAI PLAN CHECN <br />OTMEP <br />STATE BUIlDINO SURCHARGE <br />CITY OF EVERETT PUBLIC WORKS <br />LOCAL SALES <br />TAX CODE IS 3105 TOTAL <br />FEE <br />SUB TOTAL 5 <br />PERMIT S <br />TOTAL FEE S <br />RECEIPT NO. <br />